Measuring Pediatric Hospital Readmission Rates to Drive Quality Improvement

Nakamura, Mari; Toomey, Sara L.; Zaslavsky, Alan M.; Berry, Jay G.; Lorch, Scott A.; Jha, Ashish K.; Bryant, Maria C.; Geanacopoulos, Alexandra T.; Loren, Samuel S.; Pain, Debanjan; Schuster, Mark A.

doi:10.1016/j.acap.2014.06.012

Cited by 69 publications

(54 citation statements)

References 63 publications

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“…Finally, repeated hospitalization may lead to social and clinical problems for the family and child, disorganization of family functioning, and consequences for the child's physical and emotional development, in addition to increasing the potential for developing hospital infections, especially in children with chronic comorbidities 28 .…”

Section: Discussionmentioning

confidence: 99%

Características e fatores associados à hospitalização nos primeiros anos de vida: coorte de nascimentos de Pelotas de 2004, Rio Grande do Sul, Brasil

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Características e fatores associados à hospitalização nos primeiros anos de vida: coorte de nascimentos de Pelotas de 2004, Rio Grande do Sul, Brasil

et al. 2017

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“…44 Readmission rates are not solely an indicator of discharge quality; they are a measure of the entire health system, as well as socioeconomic factors and patient disease. 38,45,46 There is also no consensus on the optimal readmission interval. The Centers for Medicare and Medicaid Services uses 30 days for adult readmissions measures; however, some studies have used 7, 14, or 15 days.…”

Section: Figurementioning

confidence: 99%

A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children

Tyler

Logsdon

et al. 2016

Pediatrics

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OBJECTIVE: To assess the impact of a quality improvement collaborative on quality and efficiency of pediatric discharges. METHODS: This was a multicenter quality improvement collaborative including 11 tertiary-care freestanding children’s hospitals in the United States, conducted between November 1, 2011 and October 31, 2012. Sites selected interventions from a change package developed by an expert panel. Multiple plan–do–study–act cycles were conducted on patient populations selected by each site. Data on discharge-related care failures, family readiness for discharge, and 72-hour and 30-day readmissions were reported monthly by each site. Surveys of each site were also conducted to evaluate the use of various change strategies. RESULTS: Most sites addressed discharge planning, quality of discharge instructions, and providing postdischarge support by phone. There was a significant decrease in discharge-related care failures, from 34% in the first project quarter to 21% at the end of the collaborative (P < .05). There was also a significant improvement in family perception of readiness for discharge, from 85% of families reporting the highest rating to 91% (P < .05). There was no improvement in unplanned 72-hour (0.7% vs 1.1%, P = .29) and slight worsening of the 30-day readmission rate (4.5% vs 6.3%, P = .05). CONCLUSIONS: Institutions that participated in the collaborative had lower rates of discharge-related care failures and improved family readiness for discharge. There was no significant improvement in unplanned readmissions. More studies are needed to evaluate which interventions are most effective and to assess feasibility in non–children’s hospital settings.

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“…These limitations in readmissions research might explain some of the counterintuitive findings observed thus far 7,14,15 and why tools that predict readmissions with high sensitivity and specificity are not yet available. 5,16 For example, although a high-functioning pediatric medical home that is focused on access, coordination, and comprehensive care may be protective against such postdischarge utilization, 2,17 this question remains largely unanswered.…”

Section: What This Study Addsmentioning

confidence: 99%

“…Returning to the hospital or emergency department (ED) shortly after discharge has become a major focus of national policy, research, and quality improvement initiatives, 1,2 based on the assumption that a number of these visits reflect failures along the care continuum and are therefore preventable. Despite the intense attention, much remains unknown about pediatric readmissions and ED visits after a hospitalization.…”

Section: What This Study Addsmentioning

confidence: 99%

The Medical Home and Hospital Readmissions

et al. 2015

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BACKGROUND AND OBJECTIVE: Despite considerable attention, little is known about the degree to which primary care medical homes influence early postdischarge utilization. We sought to test the hypothesis that patients with medical homes are less likely to have early postdischarge hospital or emergency department (ED) encounters.METHODS: This prospective cohort study enrolled randomly selected patients during an acute hospitalization at a children's hospital during 2012 to 2014. Demographic and clinical data were abstracted from administrative sources and caregiver questionnaires on admission through 30 days postdischarge. Medical home experience was assessed by using Maternal and Child Health Bureau definitions. Primary outcomes were 30-day unplanned readmission and 7-day ED visits to any hospital. Logistic regression explored relationships between outcomes and medical home experiences. RESULTS:We followed 701 patients, 97% with complete data. Thirty-day unplanned readmission and 7-day ED revisit rates were 12.4% and 5.6%, respectively. More than 65% did not have a medical home. In adjusted models, those with medical home component "having a usual source of sick and well care" had fewer readmissions than those without (adjusted odds ratio 0.54, 95% confidence interval 0.30-0.96). Readmissions were higher among those with less parent confidence in avoiding a readmission, subspecialist primary care providers, longer length of index stay, and more hospitalizations in the past year. ED visits were associated with lack of parent confidence but not medical home components.CONCLUSIONS: Lacking a usual source for care was associated with readmissions. Lack of parent confidence was associated with readmissions and ED visits. This information may be used to target interventions or identify high-risk patients before discharge. WHAT'S KNOWN ON THIS SUBJECT:Receiving primary care in a high-quality medical home may lead to reductions in hospital or emergency department (ED) utilization; however, the relationship between the medical home and postdischarge hospitalizations and ED visits is poorly understood.WHAT THIS STUDY ADDS: Readmission rates vary markedly based on data source and definition. Unplanned readmissions were associated with absence of a usual source of well and sick care but not other medical home components. Lack of parent confidence at discharge identified patients at high risk for readmissions and ED visits shortly after discharge.

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Measuring Pediatric Hospital Readmission Rates to Drive Quality Improvement

Cited by 69 publications

References 63 publications

Características e fatores associados à hospitalização nos primeiros anos de vida: coorte de nascimentos de Pelotas de 2004, Rio Grande do Sul, Brasil

Características e fatores associados à hospitalização nos primeiros anos de vida: coorte de nascimentos de Pelotas de 2004, Rio Grande do Sul, Brasil

A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children

The Medical Home and Hospital Readmissions

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